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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’re like me and enjoy a little inside baseball in the EHR world, then you have to watch what’s going on with EHR use in the government. In many ways, it’s like passing that car wreck on the freeway. There’s no way you can pass by without taking a look and seeing what’s gone on and what’s still going on. You want to know what’s happening.

A car wreck might be an apt comparison since we’re talking about the various government EHR situations. For those who haven’t followed this as closely, here’s a quick recap.

The DoD had the awful AHLTA EHR system. The VA had (and still has) their own homegrown VistA EHR system which most users seem to like. After a bunch of political jousting back and forth, the DoD did a $9+ billion RFP and finally selected Cerner EHR (although, Leidos was really the lead company and much of the $9 billion was going to them and not Cerner).

Meanwhile, the Coast Guard had selected Epic as their EHR. Long story short, things didn’t work out and the Coast Guard stopped implementing Epic and went back to paper. Yes, I said that right. They had to go back to paper.

Near the start of 2017, word came out that the VA was likely to replace their current VistA EHR with a commercial EHR replacement. That process is ongoing.

In the last week, the Coast Guard published their RFI to purchase an EHR. I guess that’s the final nail in the coffin for Epic at the Coast Guard.

I’m sure I’m leaving out some other government organizations that have EHR or are looking for an EHR. However, these are some of the high profile ones. As we sit here today, the question remains, which EHR will the VA and Coast Guard choose?

The obvious choice to everyone watching this is that the VA and Coast Guard and every other government organization that needs an EHR should go with Cerner. Interoperability between the DoD and VA has been awful and you’d think that having one EHR would help that situation. Plus, shouldn’t the VA be able to benefit from the experience the DoD has had implementing Cerner already? Not to mention, shouldn’t the VA and Coast Guard be able to get a discount from Cerner for bundling the purchase or does that not happen with $8 billion purchases.

The problem is that most of us (including me) don’t know all the politics at play. What seems completely obvious to us outside observers misses many of the political and cultural nuances at play in this situation. I’m not saying those nuances are right or accurate, but you can be sure that the EHR selection decision is going to have a lot of people chiming in with their own personal biases.

One simple example that’s easy to understand is you could see the VA making the case for why they should go with a commercial version of the VistA EHR that they’re already familiar within their organization. It’s hard for me to see them making this decision, but you can see why one could make a pretty solid argument for why choosing a commercial version of VistA would be a good idea.

When it comes to the interoperability potential I mentioned above, it’s sad to ask, but is having all of these organizations on the same EHR really that much better? We’re not talking about the government implementing a single instance EHR that’s shared across all organization. That would never happen, so even if the DoD and VA both buy from Cerner, they’re still going to need an interface between the systems. This should be presumably easier, but you can be sure it’s not going to be as turnkey as one might imagine it to be.

No doubt we’ll be watching to see what the Coast Guard and VA decide. Which EHR do you think they’ll choose? Which EHR should they choose and why? I look forward to hearing your thoughts in the comments.

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

HL7 has announced the release of a new version of FHIR designed to link it with real-world concepts and players in healthcare, marking the third of five planned updates. It’s also issuing the first release of the US Core Implementation Guide.

FHIR release 3 was produced with the cooperation of hundreds of contributors, and the final product incorporates the input of more than 2,400 suggested changes, according to project director Grahame Grieve. The release is known as STU3 (Standard for Trial Use, release 3).

Key changes to the standard include additional support for clinical quality measures and clinical decision support, as well as broader functionality to cover key clinical workflows.

In addition, the new FHIR version includes incremental improvements and increased maturity of the RESTful API, further development of terminology services and new support for financial management. It also defined an RDF format, as well as how FHIR relates to linked data.

HL7 is already gearing up for the release of FHIR’s next version. It plans to publish the first draft of version 4 for comment in December 2017 and review comments on the draft. It will then have a ballot on the version, in April 2018, and publish the new standard by October 2018.

Among those contributing to the development of FHIR is the Argonaut project, which brings together major US EHR vendors to drive industry adoption of FHIR forward. Grieve calls the project a “particularly important” part of the FHIR community, though it’s hard to tell how far along its vendor members have come with the standard so far.

To date, few EHR vendors have offered concrete support for FHIR, but that’s changing gradually. For example, in early 2016 Cerner released an online sandbox for developers designed to help them interact with its platform. And earlier this month, Epic announced the launch of a new program, helping physician practices to build customized apps using FHIR.

In addition to the vendors, which include athenahealth, Cerner, Epic, MEDITECH and McKesson, several large providers are participating. Beth Israel Deaconess Medical Center, Intermountain Healthcare, the Mayo Clinic and Partners HealthCare System are on board, as well as the SMART team at the Boston Children’s Hospital Informatics Program.

Meanwhile, the progress of developing and improving FHIR will continue. For release 4 of FHIR, the participants will focus on record-keeping and data exchange for the healthcare process. This will encompass clinical data such as allergies, problems and care plans; diagnostic data such observations, reports and imaging studies; medication functions such as order, dispense and administration; workflow features like task, appointment schedule and referral; and financial data such as claims, accounts and coverage.

Eventually, when release 5 of FHIR becomes available, developers should be able to help clinicians reason about the healthcare process, the organization says.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare Scene sat down with Scott Stuewe, Director at Cerner Network and Daniel Cane, CEO & Co-Founder at Modernizing Medicine, where we talked about Cerner’s participation in CommonWell and Modernizing Medicine’s announcement to join CommonWell. This was a great opportunity to learn more about the progress CommonWell has made.

During our discussion, we talk about where CommonWell is today and where it’s heading in the future. Plus, we look at some of the use cases where CommonWell works today and where they haven’t yet build out that capability. We also talk about how the CommonWell member companies are working together to make healthcare interoperability a reality. Plus, we talk a bit about the array of interoperability solutions that will be needed beyond CommonWell. Finally, we look at where healthcare interoperability is headed.

In the “After Party” video we continued our conversation with Scott and Daniel where we talked about the governance structure for CommonWell and how it made decisions. We also talked about the various healthcare standards that are available and where we’re at in the development of those standards. Plus, we talk about the potential business model for EHR vendors involved in CommonWell. Scott and Daniel finish off by talking about what we really need to know about CommonWell and where it’s heading.

CommonWell is a big part of many large EHR vendors interoperability plans. Being familiar with what they’re doing is going to be important to understand how healthcare data sharing will or won’t happen in the future.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Winyen Wu, Technology and Health Trend Blogger and Enthusiast at Stericycle Communication Solutions as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms
In recent years, there has been a trend in providers switching Electronic Health Record (EHR) systems: according to Software Advice, the number of buyers replacing EHR software has increased 59% since 2014. In a survey by KLAS, 27% of medical practices are looking to replace their EHR while another 12% would like to but cannot due to financial or organizational constraints. By 2016, almost 50% of large hospitals will replace their current EHR. This indicates that the current EHR products on the market are not meeting the needs of physicians.

What are the reasons for switching EHRs?

Complexity and poor usability: Many physicians find that it takes too many clicks to find the screen that they need, or that it is too time consuming to fill out all the checkboxes and forms required

Poor technical support: Some physicians may be experiencing unresponsive or low quality support from their EHR vendor

Consolidation of multiple EHRs: After consolidating practices, an organization will choose to use only one EHR as opposed to having multiple systems in place

Outgrowing functionality or inadequate systems: Some current EHRs may meet stage 1 criteria for meaningful use, but will not meet stage 2 criteria, which demand more from an EHR system.

Which companies are gaining and losing customers?

Epic and Cerner are the top programs in terms of functionality according to a survey by KLAS; cloud-based programs Athenahealth and eClinicalWorks are also popular

Companies that are getting replaced include GE Healthcare, Allscripts, NextGen Healthcare, and McKesson; 40-50% of their customers reported potential plans to move

What are providers looking for in choosing an EHR?

Ability to meet Meaningful Use standards/criteria: In September 2013, 861 EHR vendors met stage 1 requirements of meaningful use while only 512 met stage 2 criteria for certification, according to the US Department of Health and Human Services. Because stage 2 criteria for meaningful is more demanding, EHRs systems are required to have more sophisticated analytics, standardization, and linkages with patient portals.

Interoperability: able to integrate workflows and exchange information with other products

Company reliability: Physicians are looking for vendors who are likely to be around in 20 years. Potential buyers may be deterred from switching to a company if there are factors like an impending merger/acquisition, senior management issues, declining market share, or internal staff system training issues.

Is it worth it?
In a survey conducted by Family Practice Management of physicians who switched EHRs since 2010, 59% said their new EHRs had added functionality, and 57% said that their new system allowed them to meet meaningful use criteria, but 43% said they were glad they switched systems and only 39% were happy with their new EHR.

5 Things to consider when planning to switch EHRs

Certifications and Compliance: Do your research. Does your new vendor have customers who have achieved the level of certification your organization hopes to achieve? Does this new vendor continually invest in the system to make updates with changing regulations?

Customer Service: Don’t be shy. Ask to speak to at least 3 current customers in your specialty and around your size. Ask the tough questions regarding level of service the vendor provides.

Interoperability: Don’t be left unconnected. Ensure your new vendor is committed to interoperability and has concreate examples of integration with other EHR vendors and lab services.

Reliability and Longevity: Don’t be left out to dry. Do digging into the vendor’s financials, leadership changes and staffing updates. If they appear to be slimming down and not growing this is a sign that this product is not a main focus of the company and could be phased out or sold.

Integration with Current Services: Don’t wait until it’s too late. Reach out to your current providers (like appointment reminders) and ensure they integrate with your new system and set up a plan for integrating the two well in advance.

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

It’s beginning to look like the famed VistA EHR may be shelved by the Department of Veterans Affairs, probably to be replaced by a commercial EHR rollout. If so, it could spell the end of the VA’s involvement in the highly-rated open source platform, which has been in use for 40 years. It will be interesting to see how the commercial EHR companies that support Vista would be impacted by this decision.

The first rumblings were heard in March, when VA CIO LaVerne Council suggested that the VA wasn’t committed to VistA. Now Council, who supervises the agency’s $4 billion IT budget, sounds a bit more resolved. “I have a lot of respect for VistA but it’s a 40-year-old product,” Council told Politico. “Looking at what technology can do today that it couldn’t do then — it can do a lot.”

Her comments were echoed by VA undersecretary for health David Shulkin, who last month told a Senate hearing that the agency is likely to replace VistA with commercial software.

Apparently, the agency will leave VistA in place through 2018. At that point, the agency expects to begin creating a cloud-based platform which may include VistA elements at its core, Politico reports. Council told the hearing that VA IT leaders expect to work with the ONC, as well as the Department of Defense, in building its new digital health platform.

Particularly given its history, which includes some serious fumbles, it’s hardly surprising that some Senate members were critical of the VA’s plans. For example, Sen. Patty Murray said that she was still disappointed with the agency’s 2013 decision back to call of plans for an EHR that integrated fully with the DoD. And Sen. Richard Blumenthal expressed frustration as well. “The decades of unsuccessful attempts to establish an electronic health record system that is compatible across the VA in DoD has caused hundreds of millions of taxpayer dollars to be wasted,” he told the committee.

Now, the question is what commercial system the VA will select. While all the enterprise EHR vendors would seem to have a shot, it seems to me that Cerner is a likely bet. One major reason to anticipate such a move is that Cerner and its partners recently won the $4.3 billion contract to roll out a new health IT platform for the DoD.

Not only that, as I noted in a post earlier this year, the buzz around the deal suggested that Cerner won the DoD contract because it was seen as more open than Epic. I am taking no position on whether there’s any truth to this belief, nor how widespread such gossip may be. But if policymakers or politicians do see Cerner as more interoperability-friendly, that will certainly boost the odds that the VA will choose Cerner as partner.

Of course, any EHR selection process can take crazy turns, and when you grow in politics the process can even crazier. So obviously, no one knows what the VA will do. In fact, given their battles with the DoD maybe they’ll go with Epic just to be different. But if I were a Cerner marketer I’d like my odds.

The following is a guest blog post by Justin Campbell, Vice President, Galen Healthcare.
A recent Black Book survey of hospital executives and IT employees who have replaced their Electronic Health Record system in the past three years paints a grim picture. Respondents report higher than expected costs, layoffs, declining revenues, disenfranchised clinicians and serious misgivings about the benefits of switching systems. Specifically:

14% of all hospitals that replaced their original EHR since 2011 were losing inpatient revenue at a pace that wouldn’t support the total cost of their replacement EHR

87% of hospitals facing financial challenges now regret the decision to change systems

63% of executive level respondents admitted they feared losing their jobs as a result of the EHR replacement process

66% of system users believe that interoperability and patient data exchange functionality have declined

Surely, this was not the outcome expected when hospitals rushed to replace paper records in response to Congressional incentives (and penalties) included in the 2009 American Recovery and Reinvestment Act.

But the disappointment reflected in this survey only sheds light on part of the story. The majority of hospitals depicted here were already in financial difficulty. It is understandable that they felt impelled to make a significant change and to do so as quickly as possible. But installing an electronic record system, or replacing one that is antiquated, requires much more than a decision to do so. We should not be surprised that a complex undertaking like this would be burdened by complicated and confusing challenges, chief among which turned out to be “usability” and acceptance.

Another Black Book report, this one from 2013, revealed:

66% of doctors using EHR systems did not do so willingly

87% of those unwilling to use the system claimed usability as their primary complaint

84% of physician groups chose their EHR to reach meaningful use incentives

92% of practices described their EHR as “clunky” and/or difficult to use

None of this should surprise us but we need to ask: was usability really the key driver for EHR replacement? Is usability alone accountable for lost revenue, employment anxiety and buyers’ remorse? Surely organizations would not have dumped millions into failed EHR implementations only to rip-and-replace them due to usability problems and provider dissatisfaction. Indeed, despite the persistence of functional obstacles such as outdated technology, hospitals continue to make new EMR purchases. Maybe the “reason for the rip-and-replace approach by some hospitals is to reach interoperability between inpatient and outpatient data,” wrote Dr. Donald Voltz, MD in EMR and EHR.

Interoperability is linked to another one of the main drivers of EHR replacement: the mission to support value-based care, that is, to improve the delivery of care by streamlining operations and facilitating the exchange of health information between a hospital’s own providers and the caregivers at other hospitals or health facilities. This can be almost impossible to achieve if hospitals have legacy systems that include multiple and non-communicative EHRs.

As explained by Chief Nurse Executive Gail Carlson, in an article for Modern Healthcare, “Interoperability between EHRs has become crucial for their successful integration of operations – and sometimes requires dumping legacy systems that can’t talk to each other.”

Many hospitals have numerous ancillary services, each with their own programs. The EHRs are often “best of breed.” That means they employ highly specialized software that provides excellent service in specific areas such as emergency departments, obstetrics or lab work. But communication between these departments is compromised because they display data differently.

In order to judge EHR replacement outcomes objectively, one needs to not just examine the near-term financials and sentiment (admittedly, replacement causes disruption and is not easy), but to also take a holistic view of the impact to the system’s portfolio by way of simplification and future positioning for value-based care. The majority of the negative sentiment and disappointing outcomes may actually stem from the migration and new system implementation process in and of itself. Many groups likely underestimated the scope of the undertaking and compromised new system adoption through a lackluster migration.

Not everyone plunged into the replacement frenzy. Some pursued a solution such as dBMotion to foster care for patients via intercommunications across all care venues. In fact, Allscripts acquired dBMotion to solve for interoperability between its inpatient solution (Eclipsys SCM) and its outpatient EMR offering (Touchworks). dBMotion provides a solution for those organizations with different inpatient and outpatient vendors, offering semantic interoperability, vocabulary management, EMPI and ultimately facilitating a true community-based record.

Yet others chose to optimize what they had, driven by financial constraints. There is a thin line separating EHR replacement from EHR optimization. This is especially true for those HCOs that are neither large enough nor sufficiently funded to be able to afford a replacement; they are instead forced to squeeze out the most value they can from their current investment.

The optimization path is much more pronounced with MEDITECH clients, where a large percentage of their base remains on the legacy MAGIC and C/S platforms.

Denni McColm, a hospital CIO, told healthsystemCIO why many MEDITECH clients are watching and waiting before they commit to a more advanced platform:

“We’re on MEDITECH’s Client/Server version, which is not their older version and not their newest version, and we have it implemented really everywhere that MEDITECH serves. So we have the hospital systems, home care, long-term care, emergency services, surgical center — all the way across the continuum. We plan to go to their latest version sometime in the next few years to get the ambulatory interface for the providers. It should be very efficient — reduced clicks, it’s mobile friendly, and our docs are anxious to move to it,” but we’ll decide when the time is right, she says.

What can we discern from these different approaches and studies? It’s too early to be sure of the final score. One thing is certain though: the migrations and archival underpinnings of system replacement are essential. They allow the replacement to deliver on the promise of improved usability, enhanced interoperability and take us closer to the goal of value-based care.

About Justin CampbellJustin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.
Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

After some seven years of watching the US government push interoperability among health records, and hearing how far we are from achieving it, I assumed that fundamental divergences among electronic health records at different sites posed problems of staggering complexity. I pricked up my ears, therefore, when John Orosco, CTO of Sansoro Health, said that they could get EHRs to expose real-time web services in a few hours, or at most a couple days.

What does Sansoro do? Its goal, like the FHIR standard, is to give health care providers and third-party developers a single go-to API where they can run their apps on any supported EHR. Done right, this service cuts down development costs and saves the developers from having to distribute a different version of their app for different customers. Note that the SMART project tries to achieve a similar goal by providing an API layer on top of EHRs for producing user interfaces, whereas Sansoro offers an API at a lower level on particular data items, like FHIR.

Sansoro was formed in the summer of 2014. Researching EHRs, its founders recognized that even though the vendors differed in many superficial ways (including the purportedly standard CCDs they create), all EHRs dealt at bottom with the same fields. Diagnoses, lab orders, allergies, medications, etc. are the same throughout the industry, so familiar items turn up under the varying semantics.

FHIR was just starting at that time, and is still maturing. Therefore, while planning to support FHIR as it becomes ready, Sansoro designed their own data model and API to meet industry’s needs right now. They are gradually adding FHIR interfaces that they consider mature to their Emissary application.

Sansoro aimed first at the acute care market, and is expanding to support ambulatory EHR platforms. At the beginning, based on market share, Sansoro chose to focus on the Cerner and Epic EHRs, both of which offer limited web services modules to their customers. Then, listening to customer needs, Sansoro added MEDITECH and Allscripts; it will continue to follow customer priorities.

Although Orosco acknowledged that EHR vendors are already moving toward interoperability, their services are currently limited and focus on their own platforms. For various reasons, they may implement the FHIR specification differently. (Health IT experts hope that Argonaut project will ensure semantic interoperability for at least the most common FHIR items.) Sansoro, in contrast can expose any field in the EHR using its APIs, thus serving the health care community’s immediate needs in an EHR-agnostic manner. Emissary may prevent the field from ending up again the way the CCD has fared, where each vendor can implement a different API and claim to be compliant.

This kind of fragmented interface is a constant risk in markets in which proprietary companies are rapidly entering an competing. There is also a risk, therefore, that many competitors will enter the API market as Sansoro has done, reproducing the minor and annoying differences between EHR vendors at a higher level.

But Orosco reminded me that Google, Facebook, and Microsoft all have competing APIs for messaging, identity management, and other services. The benefits of competition, even when people have to use different interfaces, drives a field forward, and the same can happen in healthcare. Two directions face us: to allow rapid entry of multiple vendors and learn from experience, or to spend a long time trying to develop a robust standard in an open manner for all to use. Luckily, given Sansoro and FHIR, we have both options.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

UPDATE: Here’s the video recording of my interview with Helen Waters from MEDITECH

Many in the large hospital EHR space have argued that it’s a two horse race between Cerner and Epic. However, many forget how many users MEDITEH still has using its healthcare IT products. Not to mention MEDITECH was originally founded in 1969 and has a rich history working in the space. On Friday, January 29, 2016 at 1 PM ET (10 AM PT), I’ll be sitting down with Helen Waters, VP at MEDITECH to talk about the what’s happening with MEDITECH and where MEDITECH fits into the healthcare IT ecosystem.

You can join my live conversation with Helen Waters and even add your own comments to the discussion or ask Helen questions. All you need to do to watch live is visit this blog post on Friday, January 29, 2016 at 1 PM ET (10 AM PT) and watch the video embed at the bottom of the post or you can subscribe to the blab directly. We’ll be doing a more formal interview for the first 30 minutes and then open up the Blab to others who want to add to the conversation or ask us questions. The conversation will be recorded as well and available on this post after the interview.

We’re interested to hear Helen’s comments about the culture and history of MEDITECH along with what MEDITECH’s doing with its products to change perceptions and misconceptions around the MEDITECH product. We’ll also be sure to ask Helen about important topics like interoperability and physician dissatisfaction (“Too Many Clicks!”). We hope you’ll join us to learn more about what’s happening with MEDITECH.

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Numerous medical advances can be traced back to development and research conducted by the U.S. military. In most instances, these developments were directly related to mitigating casualties and disease during times of war. The U.S. Civil War is seen as one of the most influential military events to advance modern medicine. Life-saving amputations, anesthesia, thoracic surgery, wound treatment, facial reconstruction, and the inception of the ambulance-to-ER transport system all originated with military intervention. While today’s medical advancements have certainly surpassed anything ever imagined by Civil War surgeons a century and a half ago, the model of healthcare innovations spurring from military initiatives remains steadfast. In fact, the U.S. military is one of the largest payers and providers within the modern day healthcare system, and the Department of Defense’s (DoD) current Electronic Health Records (EHR) project presents an unparalleled opportunity for development and implementation of an innovative solution that will inform advancement in both the military and private health systems. With this DoD decision, the contracted vendors will have opportunities and challenges to fulfill the reality of this EHR, and all other vendors will have an opportunity to innovate and capitalize on the private sector.

While the massive undertaking to update the DoD’s EHR system holds great promise, many health information technology experts have expressed skepticism surrounding the approach and associated costs of implementation via a complex public-private partnership model. Skeptics also continue to point to the failed implementation of HealthCare.gov as a litmus test for potential success. Potential pitfalls aside, the DoD EHR project does create opportunity for health information technology (HIT) vendors and start-ups across the industry who recognize that disruptive innovation can easily erupt in the private sector, and new market opportunities will arise as a result of this government-private sector partnership. Both critics and supporters should pay attention to the developments in the coming months.

The DoD contract will likely span 10 years with the aim of creating a new electronic health system to replace the DoD’s Armed Forces Health Longitudinal Technology Application (AHLTA). This collective effort, referred to as the Defense Healthcare Management System Modernization (DHMSM), or “Dimsum” as commonly called by health IT insiders, creates opportunity for development of a commercial, off-the-shelf version of the government system. The price tag for this contracted venture is $4.34 billion, but that certainly may increase as development evolves. Compared to prior attempts by the DoD and the U.S. Department of Veterans Affairs (VA) to create an integrated electronic health record at an estimated costs of $28 billion, the $4.34 billion price tag appears to offer staggering savings; however, the two projects differ greatly. The initial integrated EHR was scrapped due to cost estimates and disagreement between DoD and VA leadership, ultimately leading to DHMSM and the VA moving forward with a separate update to that EHR, which later became known as the Veterans Health Information Systems and Technology Architecture (VistaA) program. Despite leadership disagreements and technological difficulties, one of the goals of DHMSM is interoperability between the new DoD system and the VA system.

Dr. Jonathan Woodson, assistant secretary of defense for health affairs, articulated the need for interoperability between both military and private systems during a July 29 briefing. He stated that the goal is for the new military system and the private sector systems to become interoperable. If private sector health IT vendors – whether partners in the contract or not – figure out how to easily exchange data and communicate with other platforms, they will truly capitalize on this opportunity and improve care simultaneously.

Interoperability between private and military systems is underway. For example, the Military Health System in Colorado Springs, Colorado joined efforts with the Colorado Regional Information Organization (CORHIO) and is making progress with interoperability and data sharing through the utilization of Health Information Exchanges (HIEs). They are able to share patient information and data in both private and military health systems. As presented at this years’ HIMSS conference, the initial collaboration and efforts between the two organizations have shown promising results.

Dr. Karen DeSalvo, federal health IT coordinator, echoes further support and enthusiasm for DHMSM and private system interoperability. “[The DHMSM is] an important step toward achieving a nationwide interoperable health IT infrastructure.” As contributors to the Office of the National Coordinators Interoperability Roadmap, Dr. Karen DeSalvo and her cohorts appreciate the potential impact of establishing interoperability on such a large scale. It will be an incredible milestone in HIT history to attain true interoperability of military and private systems. Conversely, if large-scale interoperability is not achieved, it may lead to more spending and potentially the demise of the project altogether. To the chagrin of DHMSM supporters, this failure would only support assertions that the failed Healthcare.gov website was only the beginning of a litany of government HIT challenges. But given the track record of medical advances related to military research and development, the DHMSM project will likely achieve some level of interoperability and attain the goals set during the initial request-for-proposal phase.

The next opportunity and challenge is already happening. The selected DHMSM health IT vendors must maintain their private sector customer base while rapidly developing the new military system. This is no small task. Doing so will require additional resources and new partnerships to successfully manage this effort. It also means that if these vendors are not successful, their customer base may decide to switch EHRs and implement another EHR platform altogether. Either way, there are opportunities for HIT vendors and consultants to innovate and gain entry to new markets and customers.

Alternatively, the HIT vendors not selected for the DHMSM contract are positioned to innovate and create new technologies and supporting systems. Although the military is responsible for many medical advances, numerous technological advances have been developed in the private sector and can be traced to simple beginnings in a garage or dorm room without any direct military or government involvement. Those across the HIT marketplace have the opportunity and motivation to develop new, cutting-edge technology, by capitalizing upon the bright light currently being shone on new health technologies as a means of improving patient safety and health outcomes.

Data security is another area to pay attention to in the coming months. The DHMSM is an excellent opportunity to develop sophisticated systems to protect patient health information. Conversely, creating such a massive interoperable system opens up risk for data security of all integrated systems. In an age where devices, web searching, and systems leave a trail of bread crumbs and create an internet-of-things (ioT) or web of data points, the new DHMSM system must effectively protect this web of data to avoid compromising personal and national security.

We must also consider the ability to successfully implement and adopt the DHMSM system. This type of system will require a coordinated and focused effort of massive proportions. After coordinating logistics, adopting the new system will require another heroic level of effort. Difficulties may lie in establishing proper governance between the selected HIT vendors and military projects and ensuring that all companies involved have the stamina and focus for the entire life cycle of the system. The DoD began laying the foundation for governance structures during the initial proposal process, but it is yet to be seen if all involved parties will be able to adhere to the outlined parameters and work collaboratively to create their new DHMSM system. Additionally, once the system is designed and implemented, if proper funds are not available to sustain the system, the DoD would have to consider a potential redesign.

The military’s track record with medical advances positions them to successfully implement the new DHMSM system. Remarkably, this project has the potential to lay the foundation for interoperability and data security in the U.S. Despite the obvious challenges associated with the DHMSM EHR project, a system that is able to communicate and safely share data for large populations is worth the investment. From a global perspective, many countries are far ahead of the U.S. in designing and implementing national health records (e.g. Denmark, Finland, Sweden, UK, and Australia). There is also the potential for the DHMSM system to evolve one day into a national electronic health record, but doing so would require a national paradigm shift and lot more than $4.3 billion. Additionally, the challenges associated with this initial venture will surely be exacerbated due to the scale of the project and sheer importance. Health IT vendors and start-ups not directly involved in DHMSM should remain optimistic and on the lookout for new opportunities and challenges on the horizon. If the DoD and the contracted health IT vendors can successfully develop and deploy the DHMSM system, new opportunities, research and medical advances will likely follow. It’s up to both HIT vendors and non-vendors of the DoD contract to decide whether they walk through this “door” of opportunity and make the most of this historic initiative.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

All the news at the end of the day yesterday was around Cerner (and their major partners Leidos, Accenture) winning the DoD EHR project. We’d been told the decision would come by the end of the month and you knew a decision was close once the major news organizations started writing about what a waste the DoD EHR project will be before they’d even named the winner. That’s called priming the pump. Of course, the critics make some good points about the DoD EHR project dealing with today instead of the future, and they also suggested that “We’re going to make Epic or Cerner the Standard Oil of health IT. It will become a monopoly at a time when we need to be moving to solutions that allow everyone to participate.”

I guess now that we know that Cerner has won the DoD contract, does that make them the Standard Oil of Health IT?

What we do know is that Cerner, Leidos, and Accenture were awarded the $4,336,822,777 (Our government’s so precise they got a 10 year project down to the dollar?) EHR contract with it projected to be around $9 billion over the life of the 10 year contract. That’s massive by any terms. It’s also much less than the projected $11 billion that was previously discussed. I guess competition for the DoD EHR contract brought the price down? Although, how often does the government project the costs for a project and then they balloon over the life of the project. According to Healthcare IT News, they’ll be working on bringing their first sites live in the Pacific Northwest by the end of 2016 and 1000 sites by 2022.

A lot of people have been commenting how this is a big win for Cerner and a big loss for Epic. Of course, I wrote a little over a year ago that the best thing for Epic might be to NOT win the DoD EHR contract. You can be sure that many hospital systems won’t be selecting Cerner now that they’re going to be tied up with the massive DoD EHR contract. Who does that leave? In most cases, that will leave Epic. I can’t help but wonder how many Soarian users will now decide to go to Epic instead of Cerner as well because of the Cerner win. Cerner should start working on this potential perception problem.

You can imagine the celebrations happening at the companies that won this contract. HIStalk posted a great image that shows all the partners that will be involved in the bid:

While they may be celebrating the contract now, it reminds me of startup companies who do big celebrations when they raise a round of funding. Those celebrations are premature since it’s really the start of all the hard work to come.

I personally lean more towards G Gordon Liddie’s comment on the HIStalk post on this subject:

Cerner will do as good a job as Epic would have done…which won’t be great. The federal government can’t pull off something like this.

I think this shares many people’s fears of a project this size. Others might suggest, if the government can’t roll out an insurance exchange website without major issues, how are they going to make an EHR roll out which is much more complex a success. I’m sure Cerner, Leidos, and Accenture will be thinking about this every day for the next 5-10 years.

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